Session Information
Date: Sunday, November 8, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: A
large multicentre multinational inception cohort was established to study risk
factors for atherosclerosis (AS) in SLE. We aim to describe all vascular events
and determine the predictors of atherosclerotic vascular events (AVE) in this
prospectively followed cohort over a 15 year period
Methods: Patients enter
the cohort within 15 months of SLE diagnosis (≥4 ACR criteria). Clinical
and laboratory features of SLE are collected in a standardized protocol at
yearly intervals between 2000 and 2015. Vascular events are described and
attributed on a specialized form. Events recorded include myocardial infarction
(MI), angina, congestive heart failure (CHF), intermittent claudication (PVD), transient
ischemic attack (TIA), and stroke. Diagnosis of an event was confirmed using
standard clinical criteria, relevant laboratory data and imaging where
appropriate. Attribution to AS was made on the basis of lupus disease being
inactive at the time of the event, and/or the presence of typical AS changes on
imaging or pathology and/or evidence of AS elsewhere. Factors associated with
AVE were analyzed using time to event analysis with time dependent covariates
and cox proportional hazard model.
Results: Since 2000, 1848
patients have been entered into the cohort (86.8%F, age at SLE 34.7 ± 13.4
years, disease duration at enrolment 5.6±4.2 months, mean follow-up of 6.1 ± 3.9
years). Thus far there have been 202 vascular events in 142 patients. These
include: MI (21), angina (29), CHF (49), pacemaker insertion (8), PVD (16), TIA
(29) and stroke (50). 89 of the events were attributed to active lupus and 40
to other causes.
73 events in 51 patients were
attributed to AS including: MI (15), angina (24), CHF (12), pacemaker (5), PVD
(7), TIA (7), and stroke (3). Thirteen patients in the AS group had more than
one event. Lupus duration at first AS event was 3.2 ± 2.9 years.
Table 1. Predictive Factors at
Enrolment – Univariate Analysis
|
Characteristic |
Patient that had a VE (N=51) |
Patients that did not have a VE (N=1331) |
p value |
|
Male |
17 (33.3%) |
126 (9.5%) |
<.001 |
|
Caucasian |
37 (72.5%) |
643 (48.3%) |
<.001 |
|
Age at SLE diagnosis (Mean ± SD) |
52.34 ± 15.05 |
33.99 ± 12.96 |
<.001 |
|
Smoking |
32 (62.7%) |
453 (34.0%) |
<.001 |
|
Hypertension |
30 (58.8%) |
427 (32.1%) |
<.001 |
|
Diabetes |
4/48 (7.8%) |
45/1320 (3.4%) |
<.001 |
|
Obese |
24/49 (47.1%) |
371/1287 (28.8%) |
0.01 |
|
Hypercholesterolemia |
27 (52.9%) |
458 (34.4%) |
0.024 |
|
Family history of CAD |
24 (47.1%) |
289 (21.7%) |
<.001 |
|
SLEDAI-2K (Mean ± SD) |
3.57 ± 3.82 |
5.37 ± 5.34 |
0.017 |
|
Total ACR Criteria (Mean ± SD) Serositis Renal Disorder Neurologic Disorder Immunologic Disorder |
5.00 ± 1.22 21 (41.2%) 14 (27.5%) 4 (7.8%) 43 (84.3%) |
4.91 ± 1.05 352 (26.4%) 377 (28.3%) 60 (4.5%) 1016 (76.3%) |
0.532 0.02 0.892 0.266 0.186 |
|
Anticardiolipin |
9/35 (17.6%) |
116/898 (8.7%) |
0.088 |
|
Lupus Anticoagulant |
13/36 (25.5%) |
184/928 (13.8%) |
0.057 |
|
Treated with oral steroids |
37 (72.5%) |
928 (69.7%) |
0.666 |
|
Average daily steroid dose (Mean ± SD) |
14.31 ± 16.59 |
16.49 ± 17.09 |
0.371 |
|
Treated with antimalarials |
31 (60.8%) |
913 (68.6%) |
0.239 |
|
Treated with immunosuppressives |
21 (41.2%) |
530 (39.8%) |
0.846 |
|
Treated with antihypertensives |
25 (49.0%) |
363 (27.3%) |
<.001 |
|
Treated with antihyperlipidemia |
17 (33.3%) |
123 (9.2%) |
<.001 |
Table 2. Predictive Factors at Enrolment – Multivariate
Analysis
|
Predictor |
Hazard Ratio |
95% Confidence Interval |
p value |
|
Male |
2.21 |
1.10, 4.40 |
0.025 |
|
Age at SLE diagnosis |
1.08 |
1.06, 1.10 |
<.0001 |
|
ACR Criteria – Serositis |
2.52 |
4.38, 4.60 |
0.0026 |
|
ACR Criteria – Neurological Disorder |
2.74 |
0.97, 7.73 |
0.057 |
Conclusion: Over the follow-up of an
inception cohort with SLE there were 202 vascular events but only 73 were
attributable to AS (cardiac, peripheral, CNS). Only male sex, age, and
lupus disease factors (serositis) at inception remain significant risk factors
of AVE in a multivariate analysis of a multicentre inception cohort followed
for 7 or more years. Traditional cardiovascular risk factors likely become
important over time.
To cite this abstract in AMA style:
Urowitz M, Gladman D, Anderson N, Su J. Atherosclerotic Vascular Events in a Multinational SLE Inception Cohort: Description and Predictive Risk Factors over a 15 Year Period [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/atherosclerotic-vascular-events-in-a-multinational-sle-inception-cohort-description-and-predictive-risk-factors-over-a-15-year-period/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/atherosclerotic-vascular-events-in-a-multinational-sle-inception-cohort-description-and-predictive-risk-factors-over-a-15-year-period/